Alternatives To Surgery

Medications

It is important to distinguish broadly between two types of arthritis: inflammatory arthritis (including Rheumatoid arthritis, lupus, and others) and non-inflammatory arthritis (such as osteoarthritis).

Although there is some level of inflammation present in all types of arthritis, conditions that fall into the category of true inflammatory arthritis are often very well managed with a variety of medications, and more treatments are coming out all the time. Individuals with rheumatoid arthritis and related conditions need to be evaluated and followed by a physician who specializes in those kinds of treatments, called a rheumatologist. Excellent non-surgical treatments (including many new and effective drugs) are available for these patients; those treatments can delay (or avoid) the need for surgery, and also help prevent the disease from affecting other joints.

So-called non-inflammatory conditions, including osteoarthritis (sometimes called degenerative joint disease), also sometimes respond to oral medications (either painkillers like Tylenol, or non-steroidal anti-inflammatory drugs like aspirin, ibuprofen, or celebrex,) but in many cases, symptoms persist despite that type of treatment.

It is important to avoid using narcotics (such as Tylenol #3, vicoden, percocet, or oxycodone) since they are have many side effects, are habit-forming, and make it harder to achieve pain-control safely and effectively after surgery, should that become necessary. Narcotics are designed for people with short-term pain (like after a car accident or surgery), or for people with chronic pain who are not surgical candidates. People who feel they need narcotics to achieve pain control should consider seeing a joint replacement surgeon (an orthopedic surgeon with experience in knee replacements) to see whether surgery is a better option.

Nutritional Supplementation

Nutritional supplements, like glucosamine and chondroitin, have been shown to decrease pain in many patients who use them. These products typically take 6-8 weeks to achieve their maximum effect. However, they do not work for all patients who try them, and despite what some advertisements suggest, they do not appear to regrow cartilage or reverse the arthritic process.

Visosupplementation

Joint injections, either with corticosteroids (“cortisone shots”) or with viscosupplements like Synvisc or Supartz, may also provide temporary relief. These products do not work in all people who try them, and there is some risk of infection associated with injecting the knee joint, though this is not very likely.

Exercises

There is little evidence to suggest that knee arthritis can be prevented or caused by exercises or activities, unless the knee was injured (or was otherwise abnormal) before the exercise program began. There is no evidence that, once arthritis is present in a knee joint, any exercises will alter its course. However, if exercises results in weight loss, then symptoms can be significantly decreased, although it does not alter the underlying arthritis.

However, exercise and general physical fitness have numerous other health benefits. Regular range of motion exercises and weight bearing activity are important in maintaining muscle strength and overall aerobic (heart and lung) capacity, and help prevent the development of osteoporosis, which can complicate later treatment. Certainly, people who are physically fit are more resilient and, in general, are more able to overcome the problems associated with arthritis. Physically fit people also tend to recover more quickly from surgery, should that eventually be necessary to treat the knee arthritis.